IGF-1 gets no respect

Monday, January 13, 2014

In describing Alex Rodriguez and the use of performance enhancing drugs, presumptive may be appropriately used, since as has been thoroughly noted by him and his spokespersons, he has never failed a drug test. Lance Armstrong also did not fail drug tests for PEDs but presumptive was removed from his status when he confessed to their use.

For Mr. Rodriguez, the battle continues but the specific types of drugs allegedly used are now public, after the Biogenesis files were made available in lawsuit documents. The culprits were testosterone, insulin growth factor 1 (IGF-1) and human growth hormone (HGH), the triumvirate of drugs that can be legally prescribed by a physician to treat a range of medical conditions. They may also be legally prescribed off-label to be used as the patient and physician see fit. The issue for Mr. Rodriguez is that these medications were neither prescribed by a physician nor allowed by his employer. While it is not illegal to have the substances in his body (though not proved by testing), Major League Baseball and its players union have agreed that performance enhancing drugs do not belong on the field of play.

The world has heard about HGH and testosterone, but IGF-1 is a silent partner in performance enhancement. The pituitary gland in the brain produces HGH and released into the blood stream, where it activates the liver to produce IGF-1. It is chemically similar to insulin but has a specific cell receptor that helps promote growth in almost all cells in the body, including muscle and cartilage. People need adequate levels of both HGH and IGF-1 to grow properly; lacking either chemical may be the cause of syndromes associated with short stature. IGF-1 levels in the body peak just after puberty allowing for the teenage growth spurt and fall off with age. HGH is useless unless the liver can produce the active ingredient IGF-1.

IGF-1 is responsible for cell growth and its presence decreases cell aging and death, which is a wonderful thing for growing healthy young people but may cause problems with cells that should die but do not. IGF-1 increases the growth of cancer cells and those who are deficient have a lower rate of cancer.

Pharmaceutical companies had high hopes for IGF-1 to help treat diabetes (it is closely related chemically to insulin), short stature like dwarfism and because of its cell growth properties, burns, Alzheimer’s disease and Lou Gehrig’s disease (ALS). Unfortunately, research results are mixed and potential side effects are real. There is no indication to treat New York Yankee third basemen.

The law allows Mr. Rodriguez to use performance enhancing medications as prescribed by a physician. Sports organizations worldwide ban their use to help maintain a level playing field and prevent one athlete from obtaining an unfair advantage over another and to prevent potentially lethal side effects. The ban of PEDs also prevents the creep of their use in younger athletes. If PEDs are required to succeed in the pros, then college athletes will use them; high school athletes will then begin abusing the drugs in their hope of getting college scholarships; middle school kids will use drugs to make high school varsity.

Lance Armstrong proved that his chemist was better than those employed by organized sport and he was able to beat the testing process. Alex Rodriguez remains an alleged used of PEDs because he too, has yet to test positive. Perhaps the time has come for pro sports to start drafting PhDs in chemistry.

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the rules for cheating

Monday, January 21, 2013

Lance cheated. Deep in our hearts we knew it, but until the words came out of his mouth, there was a glimmer of hope that he still could be our hero. Now he has fallen, admitting that he blood doped, used steroids and EPO and exhibited disdain to those around him, friend and foe both. The problem, however, is that sports is always filled with cheating, with some acts that the public accepts as part of the game. The distinction between what is ethically acceptable and what is not, continues to be a blurred line.

Muscle cells are a factory that take raw materials, oxygen and glucose, and turn them into energy. Training increases the ability of the body to deliver oxygen to the cells and increases their size. More efficiency and more power yield better athletic performance. Increasing the number of red blood cells in the body increases the oxygen carrying capability and that’s where blood doping and erythropoietin (EPO) come in.

EPO is a naturally occurring hormone in the body that stimulates the bone marrow to produce more red cells. Used medically, it can help patients with anemia of chronic disease whose bone marrow is suppressed to have more energy and increase daily function. But, inject it into an elite athlete and the extra oxygen increases their aerobic capacity. If the cell factory runs out of oxygen, it turns to anaerobic metabolism whose waste products shut down the ability to perform. The risk? Too many red cells can cause blood to sludge and clot in arteries and veins, causing bad things like stroke and heart attack.

Blood doping has the same end result as EPO. In effect, the athlete donates a unit (about a pint) or two of blood to himself. The blood can be stored for a month or two while the body replenishes it and just before competition, the save blood is transfused back into the athlete, increasing the red blood cell count and the oxygen delivery capacity. The risk? The same as EPO, blood clots and potential death.

Blood doping and EPO are illegal acts…cheating. But if money is no object, the same end result can be achieved quite legally. Runners who train at altitude, about 6000 feet above sea level can see an increase in their erythropoietin level. This is the body adapting to low oxygen concentrations. But intense training is difficult at altitude and performance increased but not to a great extent. However, if an athlete could sleep at altitude and train at sea level, the effect on performance could be much more dramatic. This the development of hypoxic tents (hypo=low  + oxic= oxygen), where an athlete could sleep and lounge for hours on end and then step outside and train at sea level. Erythropoietin increases in the body as do red blood cell counts and oxygen carrying capacity. It’s a perfectly legal strategy and accepted by WADA, the World Anti-Doping Agency because of its safety record.

As research improves the capabilities of training to safely enhance performance, the line between cheating and legal will continue to blur. Imagine being able to see a baseball or a tennis ball with vision better than 20/20. Will that extra split second help turn a ground out into a hit or a backhand in the net into a winner? Lasik surgery is an accepted procedure and unlikely to be considered an unethical performance enhancing operation. Oscar Pistorius, a double amputee, used Cheetah carbon fiber blades to run in the Olympics. His accomplishments were amazing as he overcame too many obstacles to count, not the least was making certain that the blades did not provide him a mechanical advantage over his non-amputee competitors. How long though before technology does create the advantage and then what?

An Olympic gold, a Super Bowl championship or a World Series ring demands years of sacrifice and training. The seduction of fame and riches often causes those with those aspirations to make unethical decisions. As much as the public adores a champion, it loathes somebody who cheats, but one person’s cheater is another’s crafty veteran. Throwing a spitball and not getting caught might get you into the baseball hall of fame, but as seen in the latest writers’ vote, drugs are a nonstarter.

Repeated studies have asked athletes whether they would choose use steroids and die early or win an Olympic medal, and the temptation of gold wins every time. Lance cheated and then lied about cheating. Perhaps the world would have forgiven the drugs but it won’t forgive the lie.

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